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General NPI Number Information
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NPI Number | 1356605877
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Entity Type | Individual
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Provider Name | GERONIMO MENDOZA URIAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2012
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 2559 MEDICAL DR STE D
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City | ALAMOGORDO
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State | NM
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Zip | 88310-8704
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Country | US
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Telephone | 575-446-5650
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Fax |
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Provider Business Mailing Address
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Address Line | 4121 SAN ANTONIO ST APT 1418
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City | ODESSA
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State | TX
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Zip | 79765-2495
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Country | US
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Telephone | 832-275-0789
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | V7580
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD2015-0230
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | BP10043455
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License Number State | TX
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